title: Assessing the internal and external validity of mobile health physical activity promotion interventions: a systematic literature review using the RE-AIM framework.
abstract: BACKGROUND
  Mobile health (mHealth) interventions are effective in promoting physical activity (PA); however, the degree to which external validity indicators are reported is unclear.
  
  
  OBJECTIVE
  The purpose of this systematic review was to use the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework to determine the extent to which mHealth intervention research for promoting PA reports on factors that inform generalizability across settings and populations and to provide recommendations for investigators planning to conduct this type of research.
  
  
  METHODS
  Twenty articles reflecting 15 trials published between 2000 and 2012 were identified through a systematic review process (ie, queries of three online databases and reference lists of eligible articles) and met inclusion criteria (ie, implementation of mobile technologies, target physical activity, and provide original data). Two researchers coded each article using a validated RE-AIM data extraction tool (reach, efficacy/effectiveness, adoption, implementation, maintenance). Two members of the study team independently abstracted information from each article (inter-rater reliability >90%) and group meetings were used to gain consensus on discrepancies.
  
  
  RESULTS
  The majority of studies were randomized controlled trials (n=14). The average reporting across RE-AIM indicators varied by dimension (reach=53.3%, 2.67/5; effectiveness/efficacy=60.0%, 2.4/4; adoption=11.1%, 0.7/6; implementation=24.4%, 0.7/3; maintenance=0%, 0/3). While most studies described changes in the primary outcome (effectiveness), few addressed the representativeness of participants (reach) or settings (adoption) and few reported on issues related to maintenance and degree of implementation fidelity.
  
  
  CONCLUSIONS
  This review suggests that more focus is needed on research designs that highlight and report on both internal and external validity indicators. Specific recommendations are provided to encourage future mHealth interventionists and investigators to report on representativeness, settings, delivery agents for planned interventions, the extent to which protocol is delivered as intended, and maintenance of effects at the individual or organizational level.
authors.affiliation: Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, United States. kaciea1@vt.edu.
authors.forename: Kacie Ca
authors.initials: KC
authors.lastname: Blackman
authors.forename: Jamie
authors.initials: J
authors.lastname: Zoellner
authors.forename: Leanna M
authors.initials: LM
authors.lastname: Berrey
authors.forename: Ramine
authors.initials: R
authors.lastname: Alexander
authors.forename: Jason
authors.initials: J
authors.lastname: Fanning
authors.forename: Jennie L
authors.initials: JL
authors.lastname: Hill
authors.forename: Paul A
authors.initials: PA
authors.lastname: Estabrooks
mesh_terms: D006293:Health Promotion; D006801:Humans; D009043:Motor Activity; D017216:Telemedicine
keywords: generalizability; mobile technology; physical activity; review